A Complete Guide To Health Insurance In The Philippines

A Complete Guide To Health Insurance In The Philippines

Health insurance is a form of financial service that provides financial security in the midst of an illness or when health calls for it. It is a form of insurance that covers medical and surgical costs, either by preventive or corrective means. In most cases, individuals who have health insurance literally pay nothing after a procedure is done. In order to enjoy such benefits, the insured pays a premium.  While health insurance is mandatory in the country through Philhealth, its coverage leaves a lot to be desired.

Illnesses especially debilitating ones can come with a hefty price – literally. If you want to spare your wallet when you’re having a rough health condition, it’s the first thing that you should consider. If you’re informed enough to get the right healthcare at the right time, you can even score more funds for your health than you need.

Before you go ahead and spend money on consulting an insurance expert’s help, here are the essentials that will give you a headstart on this subject.

General benefits of health insurance

One main reason to get insurance is to avoid going broke while taking care of your health. Whether we like it or not our health deteriorates the older we get, and even if you’re affluent enough to amass wealth that can afford you a hospital stay for a year, that still isn’t a sound financial and retirement plan.

Getting health insurance may not grant you a lump sum of money to spend for your health all the time, but it will at least pay for all the medical and services that you will be required when the needs call for it such as the following:

Inpatient Care

As the prefix “in” implies, inpatient care means taking care of a patient that needs inside the hospital. There is a need for immediate care, specialized procedures, and facilities that the patient or family cannot perform outside of the hospital. A patient is only considered an inpatient once he is admitted in the hospital or if it is written on the admission book of the hospital. Normally the benefits that encompass inpatient benefits are the following.

  1. Hospitalization
  2. Mental Health
  3. Rehabilitation
  4. Ambulance
  5. Medicine
  6. Laboratory tests
  7. Pediatrics

Outpatient Care

Outpatient differs by inpatient care by this difference alone, a patient goes to the hospital and seeks medical attention, but the patient is not admitted inside the hospital since the condition can be treated at his own home or doctor’s clinic. Most of the time, the attending physician gives or prescribes medication for the patient to prevent the condition from happening again. Outpatient care includes the following benefits.

  1. Wellness
  2. Preventive Care
  3. Laboratory tests
  4. Annual Physical Examinations (APE)

Emergency Care

Not to be mistaken as urgent care, this benefit is more focused in giving immediate care for the insured; this is the type of benefit wherein a patient walks in through delivery of an ambulance or going through the emergency room to seek immediate healing of whatever he is suffering from. These are the more serious conditions that the insured faces, these instances are acquired from accidents and similar cases of which they need to be medically attended immediately. Emergency care commonly covers the following benefits:

  1. Critical Care
  2. Travel Coverage

Optional Benefits

These are benefits that are not usually embedded with the health insurance packages. For you to avail some of these benefits, you have to pay additional premium. Optional benefits usually are the more popularly sought benefits but are separate from healing from a critical illness. From a business perspective, it is impractical for providers to include these unless more people seek for them. An example of this scenario is maternity benefits, where a provider would need to recruit more than 25 females in the group to get it.

Here are the optional benefits you can find in health insurance.

  1. Dental
  2. Optical
  3. Maternity

Health insurance from one provider to the other varies greatly, some may not even include outpatient care but if health insurance has all the benefits listed above with the right price that fits your budget, then good for you!

While health insurance doesn’t come cheap, its benefits can literally prevent you from spending a fortune when your health needs to recuperate. Health insurance companies have a network of affiliated hospitals, doctors, and specialists who serve your medical needs without you having to shell out money. The whole idea is basically paying for the monthly premium so you won’t have to cover the entire cost of hospitalization, consultations, or tests, and etc., all at once.

Ideally, the question isn’t whether you should get health insurance, but rather, which one and how many should you get?  In the Philippines, health insurance can be broken down into three categories: Private health insurance, Philhealth, and HMO.

Different types of health insurance and how they work

There are various types of health care policies in the Philippines, each has its own way of delivering their healthcare services. Despite their difference, each policy can act as a good supplement to another.  If you want to enjoy a complete healthcare service, it’s best to consider getting all these three.

1. Philhealth

PhilHealth is the health insurance provider run by the government. It is an affordable and progressive insurance program that extends financial assistance to all citizens seeking medical help, whether employed or unemployed. Membership is compulsory for all employees and half of the monthly contribution is covered by the employer while the other half is deducted from the employees’ salary.

How it works:

  • Provides a lump sum of amount for a specific illness upon admission
  • Covers a certain amount for the hospital room fee.
  • Free inpatient services in government hospitals.

Should you get a Philhealth policy?

By default, everyone in the Philippines especailly those who are formally employed is immediately covered by Philhealth and monthly premiums are automatically shared by the employer and the employee.  While PhilHealth provides a basic safety net to ease your medical expenses, its coverage falls short when it comes to compensating long term hospitalizations and severe illnesses that involve expensive treatment and procedures.

Did you know?

Paying members can opt to pay a bigger premium, which would also equate to more comprehensive and much better coverage. If you would like to learn more, we created a guide that provides details such as Philhealth contribution, coverage, and other assistance that you can avail when needed.

2. Health Maintenance Organization (HMO)

HMOs are more commonly provided by private companies to their employees for more comprehensive healthcare coverage.  HMOs provide an annual consumable amount for inpatient and outpatient services, including dental services for more expensive premiums.

How it works:

The consumable amount can be used to make use of inpatient and outpatient services without the need to pay in cash, such as the following:

  • Admission fee
  • Emergency room fee
  • Consultation fee
  • Medicines
  • Laboratory tests
  • Outpatient check-up
  • Doctor’s fee

Should you get an HMO?

If you’re employed and your company provides HMO, there’s no reason to turn this down. However, if you’re seeking to get a personal HMO policy for you and your family, you might have to weigh some considerations first to make the most out of your money. Depending on your family’s need for healthcare, it may or may not be wise to get this.

If you’re in a position where you can maximize its insurance policy, you may get more than your money’s worth with HMO. If it’s otherwise, it may not be a good idea to consider this.

3. Health insurance plan

Most insurance plans provide financial assistance for your medical and healthcare needs on a cash reimbursement process. Unlike HMOs, you will need to have some cash on hand to settle the initial hospital bills necessary to accommodate you in a private hospital. However, the amount of coverage is considerable bigger and for many critical illnesses that require intensive healthcare sustenance, the financial assistance that they provide could literally equate to a fortune.

Should you get health insurance?

Truth be told, health insurance is an investment that could easily eat up a huge portion of an average Filipino’s monthly income. Depending on the age when you signed up for a health insurance policy, the premium can be quite steep the older you become. However, you don’t have to be affluent to have one.

If you’re still young, chances are you can get one for at least PHP3,000 or less. If you’re older though, it might not be as cheap. And, if you’ve reached past the age of retirement, you may have a slim chance of getting approved for one. Also, health insurance coverage for people within the age of retirement can be expensive.

Despite all that, you could never go wrong with health insurance. Just keep in mind to get a policy that you actually need, not what’s affordable. If you want to make the most out of your policy, make sure that at least it fits with your healthcare needs and can cover your possible illnesses (based on your family history).

For an in-depth comparison of the three, you can read about here.

Choosing a provider

When choosing a health insurance provider, most of us would probably look for providers that offer the cheapest premiums.  However, like any other package, cheaper premiums could mean limited services or limited accredited physicians or hospitals.  But a health insurance policy is an important investment and worth scrutinizing. The things you should consider when choosing a good health insurance provider are:

Policy Updates

A timely critique of health insurance policies.  This is probably the most important key indicator since it details the coverage a person can avail.  This also dictates the amount of premium that you are asked to pay. For less expensive policies, it might only cover certain cases or hospitalization.  More expensive ones can include annual and comprehensive check-up and dental care. It may also include consultation that can be availed of by your dependent.  An oft-reviewed policy keeps up with the possible needs of consumers.

Some insurance companies may also stipulate in their contract or policy that even if your premium remains fixed, the coverage may increase. This is advantageous, especially because health services have a tendency to increase charges within a couple of years.  Another advantage of a health insurance policy that is regularly reviewed is that coverage of services may be expanded. It may already include particular medical procedures like dialysis if it wasn’t included before. The insurer might also add other diagnostic procedures or services, like physical therapy.

List of affiliates and accreditation

The insurer often has a panel of accredited physicians, hospitals or clinics.  Having more accredited physicians and clinics simply means that you have more choices.  And even if you contract a disease or condition — like diarrhea or food poisoning — while you’re on vacation, you can still avail of services that will be paid for by the insurer.

In addition, more accredited physicians can provide more doctors you can consult with even for rare or uncommon diseases.  Take for example, a brain tumor. Not many insurance companies have an accredited neurologist or neurosurgeon. But if they have an accredited neurologist, then you don’t have to pay for consultations or follow-ups.


These are insurance companies that offer inpatient as well as outpatient care to members.  Some insurance companies only offer inpatient services which means that if you have a respiratory problem that does not need hospitalization, the costs you incur from recovering from your condition is not covered.  This may include medicines or medical supplies. So you’ll have to opt for hospitalization for your expenses to be paid for by the insurance company. It is even possible nowadays to have a minor operation, such as removing a cyst or even a cataract operation, without being admitted to a hospital.

Health insurance providers that cover outpatient services also mean that the company covers more services, like diagnosis.  Diagnosis can take the form of an MRI, CT scan or some other expensive procedure. It may also mean that rehabilitation or physical therapy is covered.  Likewise, it’s advantageous to the insurer because it costs less than hospitalization.

Do you really need health insurance?

While health insurance doesn’t come cheap, its benefits can literally prevent you from spending a fortune when your health needs to recuperate. Health insurance companies have a network of affiliated hospitals, doctors, and specialists who serve your medical needs without having to shell out money. The whole idea is basically paying for the monthly premium so you won’t have to cover the entire cost of hospitalization, consultations, or tests, and etc.

Do you just want fuss-free health insurance that gives you access to healthcare facilities whenever you need it without having to shell out even a little cash? Then go for an HMO.

If you’re willing to pay more, work on a reimbursement type of health insurance in exchange for a lifelong coverage, while building up an investment profile on the side – health insurance policy is the way to go. The key is having a balance of both adequate coverage and affordable premium.

Leave your comment